Gliederung

Objective: The occurrence of a postoperative CSF fistula after cranial surgery is a serious event often resulting in additional and prolonged treatment. The current study evaluates possible risk factors and the clinical impact of such complications in order to develop surgical strategies for its prevention.

Methods: In this non-interventional study data sampling was prospectively performed for all patients undergoing cranial, intradural operations for all kind of pathologies. Exclusion criteria were: age <14 years and burr-hole trephinations. Possible risk factors as well as the influence of techniques for wound, dural closure, type of intracranial pathology, location of the trephination, use of drainages, were evaluated. Statistical analysis was done by chi-square-tests.

Results: 344 cases, range of age: 14–89 years. The overall incidence of CSF fistulas was 6.4%. In 14 cases they occurred before discharge (4.1%), in 8 patients thereafter (2.3%). Mainly affected grouped age is from 51–65y in 8.3% (p=0.029). The localisation of the trephination had a significant influence (p=0.033; suboccipital midline: 20%, suboccipital hemispheric: 8.3%, frontobasal: 6.3%, >1 region supratentorial (including pterional): 8.2%, temporal: 2.8%, parietal: 2.4%). Craniectomies (9.1%; p=0.042) had a higher rate than craniotomies (2.9%). Dural closure with large defects >1 cm or resected dura had the highest risk of a fistula (p=0.028), no significant differences were observed in patients with a complete dural closure, with small dural gaps, or gaps up to 1cm. A support of the dural closure significantly reduced the occurrence only in the presence of larger defects (p<0.001) independently from the material used. Risk factors had no significant influence, which was also true for the pathologies, types of sutures used for dural and skin closure. Outcome was not influenced but had clinical impact like prolonged hospital stay, re-operations and lumbar drainage.

Conclusions: The occurrence of a CSF fistula mainly depends on age (51–65 years), location of the trephination and is also significantly increased in patients with craniectomies and large dural defects (> 1 cm). Surgical strategies to lower complication rates include meticulous dural closure to avoid defects larger than 1 cm, and suture support by any graft. Further studies should focus on various surgical strategies for prevention of such CSF fistulas.